Challenges in First Nations Healthcare

I am the community health nurse working for the XeniGwet’in Band in the Nemiah Valley. I moved to the Nemiah Valley in April, 2013 to be the sole nurse for a population of approximately 230 band members in a community three hours from the closest medical center. The XeniGwet’in Band has been in the news recently for its successful win of title to the land on which they live. However, for all the strength and self-advocacy reflected in the news, there are battles fought on a daily basis; many of these battles never achieve victory. These stories are not represented in the media but I think the silent existence of these challenges prevents change from happening.

The most frustrating part of my job is battling the inequity we work so hard to deny. A child born on reserve to First Nations parents has many more hurdles to overcome that I have never had to face, simply because I happened to be born to a white, middle class family. Race, while something we hate to bring up, is an issue. I find myself fighting racism and discrimination on behalf of my patients on a regular basis. When I run errands in Williams Lake with the nursing vehicle that clearly states who I work for, I am met with questions and transferred racism as though I work for the “enemy.” Not by everyone, but often enough that it is noticeable, especially after my band successfully turned down the Taseko Mine proposal.

Health care for a First Nations person is layered in ingrained generalizations, often subconscious, but glaringly obvious from the position of the patient and to me as the nurse advocating for them and with them. At the same time, when decisions are made that don’t meet the patient’s request, racism is blamed even if it is not the case; it’s the default explanation in a world where racism so often is the case. This just widens the racial divide.

And often patients who are used to being dismissed or turned down resort to negative behaviours, which results in more dismissal and more barriers to hurdle; it’s a vicious cycle. Some patients come in just brimming with defensiveness verging on offensiveness. To those I am just another symbol of oppression, working within a rigid health care system that so often fails to meet the needs of those whose way of life does not always fit the strict scheduling of health care.

So how do I convince youth that they are valuable and strong and important and that their traditions are beautiful and powerful, knowing they will be told otherwise once they move to town where race is clearly delineated and we are defined by the colour of our skin? How do I convince youth that we are all simply human when they see inequities with their own eyes based on skin colour?

Right now, I just be me. A person who does not want to get caught up in the racial divide but who acknowledges that race is an issue and accepts the occasional wariness and defensiveness and even aggressiveness as a survival tactic for those who fight to be heard the only way they know how. I have the privilege of bearing witness to the stories and ways of life that are tied to the history of our country and to the current reality for so many. Landscape is key; it provides a visual map of stories that happened in this lifetime and stories that happened to our ancestors. Is it any wonder there is opposition to the destruction or “development” of their land?

This topic has been on my mind lately. I am frequently navigating the medical system and advocating for patients. Recently, I have also been negotiating the social assistance world and have had no end of frustration. I have listened to automated voice recordings as I am placed on hold for, literally, hours as I’ve tried to find anyone who can answer my questions. How does this feel to someone who relies on this for survival? Those who choose social assistance don’t really “choose” it; rather, they have to accept it as the only means of sustenance in a world where there are few jobs on reserve yet life off reserve involves hidden costs that are frequently unmanageable.

This is not to say that all are painted with the same brush of challenges. Overcoming the barriers happens, but I’m not sure people realize the strength it takes to continually come up against walls and still keep fighting. Our paths have different struggles and our journeys are not the same. For that I am continually struck by the sheer strength and resilience I see on a daily basis.